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FA is calculated from eigenvalues (lambda) of the diffusion tensor; Tensors are geometric entities that extend scalers, vectors, matrices to higher orders. Eigenvalues are the directional vectors; thought to reflect fiber density, axonal diameter, and myelination in white matter.

The superior parts of both the anterior and posterior limbs and the genu of the internal capsule are supplied by the lenticulostriate arteries, which are branches off of the M1 segment of the middle cerebral artery.The inferior half of the anterior limb is supplied via the recurrent artery of Heubner, which is a branch of the anterior cerebral artery.The inferior half of the posterior limb is supplied by the anterior choroidal artery, which is a branch of the internal carotid artery.

Amygdala plays primary role in the processing and memory of emotional reactions. Additional studies have shown a link between the amygdala and schizophrenia, noting that the right amygdala is significantly larger than the left in schizophrenic patients. A 2003 study found that adult and adolescent bipolar patients tended to have considerably smaller amygdala volumes and somewhat smaller hippocampal volumes

Parahippocampalgyrus – memory encoding and retrieval

Mammilary bodies - They, along with the anterior and dorsomedial nuclei in the thalamus, are involved with the processing of recognition memory.They are believed to add the element of smell to memories.

Parahippocampalgyrus – memory encoding and retrieval

A 2003 study found that adult and adolescent bipolar patients tended to have considerably smaller amygdala volumes and somewhat smaller hippocampal volumes. amygdala is found to be activated in fMRI when people observe that others are physically close to them, such as when a person being scanned knows that an experimenter is standing immediately next to the scanner, versus standing at a distance

Parahippocampalgyrus – memory encoding and retrieval

Neuroimaging

2.
Why neuroimaging?<br />The research agenda for DSM-V emphasizes a need to translatebasic and clinical neuroscience research findings into a newclassification system for all psychiatric disorders based uponpathophysiologic and etiological processes<br />Etiologic and pathophysiologically-based diagnostic system v. symptomatologic and syndromic approach of DSM-III and DSM-IV<br />Philips, ML. The Emerging Role of Neuroimaging in Psychiatry: <br />Characterizing Treatment-Relevant Endophenotypes<br />Am J Psychiatry 164:697-699, May 2007<br />

3.
Why neuroimaging?<br />Although structural imaging techniques are most useful for ruling out medical etiologies of mental status disturbances, functional neuroimaging techniques currently have an adjunctive role in the evaluation of dementia and seizure disorders and show promise for the evaluation of primary psychiatric disorders in the future.<br />Rauch SL, Renshaw PF. Clinical neuroimaging in psychiatry.<br />HarvRev Psychiatry. 1995 Mar-Apr;2(6):297-312.<br />

4.
Why neuroimaging?<br />Potential for improved early diagnosis and treatment<br />Antipsychotics are now the top-selling class of medications in the United States, with prescription sales of $14.6 billion in 2009.<br />Many clinicians worry these agents are being overprescribed and used inappropriately.<br /><ul><li>IMS Health. (2010). IMS Health reports U.S. prescription sales grew 5.1% in 2009, to $300.3 billion.

6.
Lieberman JA et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353:1209-1223</li></li></ul><li>Why neuroimaging?<br />We are surely now in a positionin psychiatry to fully embrace the potential of neuroimagingand other basic and clinical neuroscience findings to help usidentify neural system abnormalities that are more accuratethan traditional clinical measures in characterizing subgroupsof individuals who will subsequently respond best to differenttreatment modalities.<br />Philips, ML. The Emerging Role of Neuroimaging in Psychiatry: <br />Characterizing Treatment-Relevant Endophenotypes<br />Am J Psychiatry 164:697-699, May 2007<br />

10.
Schizotypal Personality Disorder<br />Cluster A: Odd/Eccentric<br />Cluster A patients tend to be detached and distrustful<br />SPD involves social withdrawal and emotional coldness but also includes oddities of thinking, perception, and communication, such as magical thinking, clairvoyance, ideas of reference, or paranoid ideation. <br />These oddities suggest schizophrenia but are never severe enough to meet its criteria. <br />People with schizotypal personality are believed to have a muted expression of the genes that cause schizophrenia.<br />http://www.merckmanuals.com/professional/sec15/ch201/ch201a.html?qt=schizotypal&alt=sh<br />

11.
Schizotypal personality disorder<br />STG is involved in the perception of emotions in facial stimuli<br />Contains Brodmann areas 41, 42 (primary auditory) and 22p (Wernicke’s)<br />Reduction of left STG gray matter volume in SPD subjects when compared to normal controls.<br />Comparisons with chronic schizophrenics previously studied showed the SPD group had a similarity of left STG gray matter volume reduction, but fewer medial temporal lobe abnormalities.<br />This finding supports the hypothesis of the importance of STG involvement in the schizophrenia spectrum disorders. <br />Possible that presence of medial temporal lobe abnormalities may help to differentiate who will develop schizophrenia and who will develop SPD<br />3D reconstruction of the cortex and superior temporal gyrus, shown in red.<br />Chandlee, CD et al. Schizotypal Personality Disorder and MRI<br />Abnormalities of Temporal Lobe Gray Matter. Biol Psychiatry 1999;45:1393–1402<br />

13.
Schizophrenia<br />A recent World Health Organization (WHO) report estimates that nearly 1% of the population in the US is affected by schizophrenia.<br />A growing body of evidence suggests that early detection and treatment of schizophrenia (and many other brain disorders) is critical in forming and predicting the course and outcome of the disorder.<br />McGlashan, T.: Early detection and intervention in schizophrenia: editors introduction.<br />Schizophr Bull 22(2), 197–199 (1996)<br />

23.
Posttraumatic stress disorder<br />Posttraumatic stress disorder (PTSD) causes recurring, intrusive recollections of an overwhelming traumatic incident that persist > 1 mo, as well as emotional numbing and hyperarousal.<br />Traumatic events commonly associated with these disorders include assaults, sexual assaults, car accidents, dog attacks, and injuries (especially burns). In young children, domestic violence is the most common cause of PTSD.<br />Treatment is with behavioral therapy, SSRIs, and antiadrenergic drugs.<br />SSRIs often help reduce emotional numbing and reexperiencing of symptoms but are less effective for hyperarousal. Antiadrenergic drugs (clonidine, prazosine) may help relieve hyperarousal symptoms, but supportive data are preliminary.<br />

26.
Posttraumatic stress disorder<br />A study reported in Nature-Neuroscience evaluated MR brain morphometry of the hippocampus in monozygotic twins discordant for PTSD. The PTSD twin was diagnosed with PTSD as a result of combat exposure in the Vietnam War. <br />The twin aspect of this study was important as it showed that individuals discordant for PTSD showed reduced hippocampal volume compared with twins where PTSD was present in neither twin. <br />This finding suggests that there may be a predisposition or vulnerability factor involved in the genesis of PTSD<br />Gilberson, MW et al.<br />Smaller hippocampal volume<br />predicts pathologic vulnerability<br />to psychological trauma.<br />Nature-Neuroscience, October 2002<br />

28.
Bipolar Disorder<br />Bipolar I disorder (BPI) affects at least 1% of the population, is associated with increased mortality, and is among the top 10 most disabling illnesses worldwide.<br />Bipolar disorders usually begin in the teens, 20s, or 30s. <br />When one takes into account those with bipolar II and subthreshold bipolar disorder capturing those with briefer or only treatment-emergent hypomania, lifetime prevalence rates approach 5%.<br />Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum <br />disorder in the National Comorbidity Survey Replication. <br />Arch Gen Psychiatry. 2007;64:543–552.<br />

29.
Bipolar disorder<br />Diagnosis is based on identification of symptoms of mania or hypomania plus a history of remission and relapse<br />Thyroxine (T4) and thyroid-stimulating hormone levels to exclude hyperthyroidism<br />Exclusion of stimulant drug abuse clinically or by urine testing<br />

30.
Bipolar disorder<br />Bipolar disorders are classified as<br />Bipolar I disorder: Defined by the presence of at least one full-fledged (ie, disrupting normal social and occupational function) manic or mixed episode and usually depressive episodes<br />Bipolar II disorder: Defined by the presence of major depressive episodes with at least one hypomanic episode but no full-fledged manic episodes<br />Bipolar disorder not otherwise specified (NOS): Disorders with clear bipolar features that do not meet the specific criteria for other bipolar disorders<br />Bipolar disorder. Merck Manual – <br />http://www.merckmanuals.com/professional/sec15/ch200/ch200c.html?qt=bipolar&alt=sh<br />

32.
Bipolar disorder<br />One major issue in diagnosing and treating bipolar disorder is the high rate of misdiagnosis or late diagnosis<br />In one community sample of diagnosed bipolar disorder patients, approximately 70% had a missed diagnosis. A total of 60% of those were diagnosed with major depressive disorder, with one third going 10 years or more without a correct diagnosis. In addition, these patients had on average 3.5 other diagnoses and saw on average four physicians before receiving the correct diagnosis.<br />Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? <br />Results of the National Depressive and Manic-depressive Association 2000 survey of individuals with bipolar disorder. <br />J Clin Psychiatry. 2003;64:161–174.<br />

33.
Bipolar disorder<br />Fewer than half of the people who were previously diagnosed with bipolar disorder could be said to have the disorder when strict diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders-IV were applied.<br />Dangers to overdiagnosis, chief among them unnecessary exposure to mood stabilizers and all their powerful side effects<br />Role for neuroimaging<br />Reference Zimmerman. Journal of Clinical Psychiatry. May 2008<br />http://www.webmd.com/bipolar-disorder/news/20080506/bipolar-disorder-overdiagnosed<br />

34.
Bipolar disorder<br />Identifying endophenotypic markers for bipolar disorder at this time would seek to serve two main goals:<br />To clarify diagnosis and discriminate the depression in bipolar disorder from that of UPD to treat accordingly<br />To identify at-risk individuals for early diagnosis with the goal of intervening before illness onset.<br />Keener, MT et al. Neuroimaging in bipolar disorder: A critical<br />review of current findings. Curr Psychiatry Rep. <br />2007 December; 9(6): 512–520<br />

35.
Two overlapping neural systems implicated in bipolar disorder. An anterior limbic subcortical system (left) is responsible for emotion processing. Lateral prefrontal cortical regions (right) are implicated in executive control. These two systems interact and overlap in ventral frontal areas such as the orbitofrontal cortex (OFC) that are responsible for decision making about emotional material and attentional control during emotional stimuli processing. Directional findings in bipolar disorder are represented by size of nodes and vertical arrows. DLFPC—dorsolateral prefrontal cortex; DMPFC—dorsomedial prefrontal cortex; Dorsal ACG—dorsal cingulate gyrus; VLPFC—ventrolateral prefrontal cortex; VMPFC—ventromedial prefrontal cortex.<br />